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PubMedDate not supplied

Time and economic cost of constipation care in nursing homes.

OBJECTIVE: Chronic constipation is a common disorder among residents in long-term care; yet the cost to the nursing home of constipation-related care is not known. The objective of this study was to quantify the nursing staff and supply-related cost of constipation care to nursing homes from the perspective of the nursing home. DESIGN: Prospective, observational time-and-motion design. SETTING: Two United States nursing homes. PARTICIPANTS: A total of 59 nursing home residents with chronic constipation and nursing staff providing constipation care to them. MEASUREMENTS: Actual time to complete constipation care-related tasks was measured via stopwatch by trained observers, and the number and professional level (eg, staff nurse, CNA) of staff performing each task was recorded. Frequency of constipation care task data was obtained through 60-day retrospective medical chart review for each subject. Nurse wage rate data was obtained from the Nursing Home Salary and Benefits Report, a US-based national source. Resident and nursing home descriptive information was also collected. RESULTS: The average cost per task occurrence ranged from 0.72 US dollars for enema administration to 1.74 US dollars for oral medication administration. Average nursing staff costs per subject per year were 1577 US dollars for oral medication administration, 215 US dollars for dietary supplement administration, 39 US dollars for constipation assessment, 17 US dollars for suppository administration, and 6 US dollars for enema administration. Based on estimates of frequency of occurrence, the total annual labor and supply cost per long-term care resident with constipation was 2253 US dollars. CONCLUSION: Nursing staff performance of constipation care-related tasks is time consuming and costly in the long-term care setting.

Journal Article↗
PubMedDate not supplied

The cost of breathing: an economic analysis of the patient cost of home oxygen therapy.

The oxygen concentrator is a popular means of delivering supplemental oxygen to the home hospice patient. The technology is notable for its reliability, convenience, and ease of use. It is the most cost effective of the various oxygen delivery systems from the institutional standpoint. Cost effectiveness from the patient standpoint has not previously been reported. We present a brief analysis of the cost of operating such a device from the perspective of the patient and suggest possible ways of addressing this cost.

Adaptation, Psychological↗
PubMed1982

Economic aspects of the rationing of nursing home beds.

State governments, with federal subsidies under the Medicaid program, are the source of the largest share of expenditures to support patients in the long-term institutional nursing care. A major state policy tool that has been evolving is the authority to approve or deny expansions in bed capacity. This paper is an analysis of how the behavior of physicians and nursing homes operates, given present reimbursement policies, could determine the allocation of beds among patients. Both general evidence of inefficient allocation and the detailed experience in the State of Rhode Island before and after a period of rapid expansion of bed capacity lend support to the conceptual model of home-operator behavior. Some alternative structural reforms in Medicaid and in the rationing of beds are suggested in the final section.

Bed Occupancy↗
PubMed2004

Multiple dimensions of socioeconomic position and obesity among employees: The Helsinki Health Study.

OBJECTIVE: To examine socioeconomic differences in obesity using several different socioeconomic indicators, ranging from childhood socioeconomic environment and adult socioeconomic status to material resources and economic satisfaction. RESEARCH METHODS AND PROCEDURES: The data derived from the Helsinki Health Study baseline surveys in 2000 and 2001. Respondents to postal surveys were middle-aged employees of the City of Helsinki (4,975 women and 1,252 men, response rate 68%). Associations between eight socioeconomic indicators and obesity (BMI > or = 30 kg/m(2)), calculated from self-reported data, were examined by fitting a series of logistic regression models. RESULTS: In women, all socioeconomic indicators except household income and economic satisfaction were associated with obesity. Parental education and childhood economic difficulties, i.e., socioeconomic conditions in childhood, remained associated with obesity after adjusting for all indicators of current socioeconomic position. Indicators of adult socioeconomic status, own education and occupational class, were no longer associated with obesity when childhood socioeconomic conditions were adjusted for. Home ownership and economic difficulties were associated with obesity after full adjustments. In men, the findings paralleled those among women, but few associations reached statistical significance. DISCUSSION: Obesity was associated with several dimensions of socioeconomic position. Childhood socioeconomic disadvantage was associated with obesity independently of the various indicators of current socioeconomic position. Associations between obesity and both educational level and occupational class disappeared after adjustment for other indicators of socioeconomic position. This suggests that the variation observed in the prevalence of obesity by these key socioeconomic indicators may reflect differences in the related material resources.

Adult↗
PubMed2006

A systematic review of the literature on home monitoring for patients with heart failure.

We conducted a systematic review of the literature for assessing the value of home monitoring for heart failure (HF) patients. The abstracts of 383 articles were read. We excluded those in which either no home monitoring was done or only the technical aspects of the telemedicine application were described. Forty-two studies met the selection criteria. We classified the results into feasibility (technical and institutional) and impact (on the clinical process, on patient health, on accessibility and acceptability of the health system, and on the economy). Evaluating the articles showed that home monitoring in HF patients is viable, given that: (1) it appears to be technically effective for following the patient remotely; (2) it appears to be easy to use, and it is widely accepted by patients and health professionals; and (3) it appears to be economically viable. Furthermore, home monitoring of HF patients has been shown to have a positive impact on: (1) the clinical process, supported by a significant improvement of patient follow-up by adjustment of treatment, diet or behaviour, as well as hospital readmissions and emergency visits reduction; (2) the patient's health, supported by a relevant improvement in quality of life, a reduction of days in hospital, and a decrease in mortality; and (3) costs resulting from the use of health resources.

Aged↗
PubMed2004

[Home-based pulmonary rehabilitation: the evidence, practical issues and medico-economics].

INTRODUCTION: Pulmonary rehabilitation is an established part of the management of chronic obstructive airway disease. For longer-term effects, extending rehabilitation into domiciliary care settings may be necessary. There are few studies evaluating precisely this modality of management in a home setting. STATE OF THE ART: This review analyses the current literature on home based rehabilitation. The benefits of pulmonary rehabilitation, the practical aspects of its application, and its advantages and limitations are detailed. The few data on economic aspects of home rehabilitation are also discussed. PERSPECTIVES: Home-based pulmonary rehabilitation is effective with positive short-term effects on quality of life, breathlessness and effort tolerance. Its practical application needs to be defined. CONCLUSION: Home-based pulmonary rehabilitation appears to be an effective intervention in patients with COPD but more studies are necessary to evaluate it fully.

Dyspnea↗
PubMed1991

Home care.

Explore the source record for details and available documents.

Contract Services↗
PubMed2001

Hemeral (daily) hemodialysis.

Hemodialysis is generally performed 3 times per week, a treatment prescription not based on optimizing the physiology of the normal kidney that maintains body homeostasis by removing water and waste products continuously and efficiently. Peritoneal dialysis might be continuous but it is not efficient. Daily hemodialysis is both frequent and efficient and theoretically should be superior to other forms of dialysis for renal replacement therapy. There is again a growing interest in daily hemodialysis (it was originally described in 1969), and a number of investigators in North America and Europe are using it. As yet, there have been no randomized prospective studies comparing hard outcomes in patients dialyzed by conventional 3-times-per-week hemodialysis with those treated with daily hemodialysis (either short high-efficiency or long, slow nocturnal). The London, Ontario, study is the first attempt to obtain comparative data. It is a 3-year study to compare daily dialysis patients with cohort controls. To date, the study shows that short daily dialysis does provide more dialysis based on Kt/V than standard therapy. However, predialysis blood urea values are not different because of improved nutrition (increased normalized protein from nitrogen appearance (nPNA) and serum albumin levels). Anemia is improved with less erythropoeitin usage in the study group. Phosphate control is good, but no better than by conventional dialysis and phosphate binders are still required unlike patients receiving nocturnal dialysis. Blood pressure and volume management is better with daily dialysis. So far, the study patients show a trend to less morbidity than their controls, but differences are not (as yet) statistically different. Blood access in daily dialysis dose not cause problems. Quality of life is significantly increased in a number of areas with daily dialysis. The economic impact of daily dialysis is not yet known; the general premise is that the higher dialysis costs attributable to an increment in treatments will be offset by increased wellness and less morbidity with the subsequent beneficial impact on drugs, hospitalizations, and so on. The provision of daily dialysis in the home has attractive economic implications. A considerable growth for this superior form of therapy is expected.

Appointments and Schedules↗